Licking Memorial Hospital Pre-Registration

Thank you for choosing Licking Memorial Hospital for your healthcare needs. For your convenience, this online form will be used to pre-register you for your upcoming services at Licking Memorial Hospital. Services you can pre-register for include surgeries, admissions, outpatient procedures/tests and maternity services.

In order to assure we are able to complete the pre-registration process prior to your arrival, this form must be completed at least three business days prior to your scheduled appointment. Business days are defined as Monday through Friday. Maternity patients can pre-register up to three months prior to their expected delivery date. A registrar may contact you to validate or obtain any additional needed information.

My scheduled appointment time is at least three business days from now.